Denial Specialist II

Are you an organized, detail-oriented healthcare professional looking for a high-impact, fully remote opportunity? We are seeking a dedicated Denial Specialist to join a dynamic healthcare support team! In this vital role, you will manage member and provider correspondence for preservice and concurrent reviews, ensuring strict compliance with regulatory standards and turn-around times.

If you thrive in an autonomous work environment where you can balance technical expertise, medical terminology, and sharp communication skills, this role offers the perfect platform to expand your healthcare administrative career with full-time conversion potential. Save time and money by working from your own quiet home workspace while supporting business-critical operations.

salary: $22.99 - $23 per hour
shift: First
work hours: 8 AM - 5 PM
education: High School

Responsibilities

Position Summary:

Generates, processes, and maintains provider and member correspondence for preservice and concurrent reviews. Ensures tasks are processed in a timely, compliant manner according to regulatory standards without requiring phone interactions.

Key Responsibilities:

• Generate denial and approval correspondence from Medical Director documentation within regulatory deadlines.

• Maintain minimum production metrics of 4 denial letters or 6–7 approval letters per hour post-training.

• Review pending denial letters, escalations, and compliance deadlines daily.

• Utilize Trucare, MS Excel, Word, Outlook, Teams, and OneNote to manage correspondence workflows.

Requirements:

• High School Diploma or GED; medical terminology knowledge required.

• 1+ years of experience processing healthcare denial management systems (claims, correspondence, appeals tracking).

• Typing speed of 60 WPM at 95% accuracy and tech-savvy proficiency in MS Office 365.

• Ability to work required weekend/evening schedule and rotating holidays.

Skills

• Denial Management
• Basic Software Skills
• Basic Accounts Receivable

Qualifications

• Years of experience: 2 years
• Experience level: Experienced

Randstad is a world leader in matching great people with great companies. Our experienced agents will listen carefully to your employment needs and then work diligently to match your skills and qualifications to the right job and company. Whether you're looking for temporary, temporary-to-permanent or permanent opportunities, no one works harder for you than Randstad.

Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.

At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact View email address on randstadusa.com.

Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility).

This posting is open for thirty (30) days.

It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.


Qualified applicants in San Francisco with criminal histories will be considered for employment in accordance with the San Francisco Fair Chance Ordinance.


Qualified applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.


We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance.